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Highlights of the 2019 Spring Representative Assembly

Physicians from across the province who gathered in Saskatoon on May 3-4, 2019, elected Dr. Allan Woo, an orthopedic surgeon, as president of the Saskatchewan Medical Association (SMA) for 2019-2020.

Dr. Woo was formally inducted during an evening ceremony on May 3, which also featured the announcement of Dr. Sean Groves as the SMA’s 2019 Physician of the Year.

The ceremony was part of the SMA’s 2019 Spring Representative Assembly (RA). Delegates to the RA also heard updates on two issues under negotiation with provincial health officials – a new MCRC agreement and new Practitioner Staff Bylaws.

The RA also heard keynote speakers talk on physician leadership strategies and lessons learned in the aftermath of the Humboldt Broncos bus crash.

New president’s address

Dr. Woo told delegates he will attempt to meet them wherever they want to discuss their concerns. He noted it has been the practice for SMA presidents to spend time at the SMA offices, as there is much work to be done there.

“But I have been given excellent advice that it might be better to get out of the office and interact with you, our members,” he said. “I am taking that advice to heart and will endeavor to do just that. I look forward to seeing you and hearing what you have to say about how we can improve the practice of medicine in Saskatchewan.”

The SMA’s Physician Support Program is expanding, which supports a key SMA strategic priority to improve physician wellness, Dr. Woo noted. “If physicians are not happy in their work they will not provide the best care to their patients.”

Dr. Woo has been on the committee reviewing Saskatchewan Health Authority Practitioner Staff Bylaws. While progress has been made, there are “very real challenges” to overcome before the review is completed, he said.

Dr. Woo also thanked outgoing SMA president Dr. Siva Karunakaran for his “steady, effective” leadership during the past year.

Outgoing president’s address

In his address to delegates and guests, Dr. Karunakaran touched on the major issues that arose during the past year, including Information and Privacy Commissioner’s reports into physicians’ access of records of patients involved in the Humboldt Broncos bus crash.

The privacy commissioner ruled that some physicians inappropriately accessed the information, saying they “snooped” in patient files. He said the physicians did not have a “need to know” the patient information, as spelled out in legislation. The physicians argued that because they had contact with the patients at some point, the patients fell under their “circle of care,” even though patients were moved to another facility and were no longer under the physician’s direct care.

“Your feedback on this topic was loud and clear: You value the notion of circle of care and your right to follow up. This appears to be more important than other issues which impact your day-to-day practice,” Dr. Karunakaran said.

In general, physicians want to know how their patients progress, even if they are no longer directly involved in care delivery, he said. They want to learn from mistakes, spot errors, and optimize care for the next time they have a similar case.

“This is entirely a routine matter in other jurisdictions and should not be a problem in Saskatchewan,” Dr. Karunakaran said.

The SMA has joined forces with the College of Physicians and Surgeons of Saskatchewan, the College of Medicine, and the Saskatchewan Health Authority, to press the health minister to make the necessary legislative changes to prevent physicians from running afoul of privacy legislation again, he told delegates.

Dr. Karunakaran touched on the relationship between the SMA and the Canadian Medical Association (CMA), noting some Saskatchewan physicians are questioning its value. He said his opinions are well-known – “I believe we are stronger together.”

He said a small PTMA such as the SMA can benefit from the national focus of the pan-Canadian association. The two organizations are working on a memorandum of understanding (MOU) that would enable work on joint projects and initiatives in areas of shared priorities, using the resources acquired by the CMA with the sale of MD Financial Management.

Dr. Karunakaran also recognized SMA administrative director Ed Hobday, who was named the recipient of the CMA Owen Adams Award of Honour, the highest award the CMA bestows on an individual who is not a member of the medical profession. Hobday has worked at the SMA for 49 years.

Minister of Health’s address

Minister Jim Reiter said he valued the relationship between the provincial government and the SMA, saying “there’s no more important group in health care in this province.”

As the province transitions to a single health authority, which was begun in December 2017, physician executives who have been placed in executive positions will play a key role, he said.

The budget was balanced, while still making significant investments in health, the minister said. Increased spending of $400 million in the mental health field shows the government’s commitment to this area. He also pointed to the government’s pledge to spend $558,000 to create an organ donor registry, which became top of mind following Broncos’ crash victim Logan Boulet’s desire to donate his organs.

The budget incorporates spending on the new Jim Pattison Children’s Hospital, and continues to fund wellness incentives – through SMA programs – as well as measures to promote recruitment and retention of rural physicians, Reiter said.

The privacy commissioner’s ruling have shown that it’s time for privacy legislation to be updated to reflect technological changes and the way in which physicians practice, he said. For anyone to label accessing records under the “circle of care” concept as snooping “is simply wrong,” Reiter added, noting he sides with physicians on this issue.

CMA president’s address

CMA president Dr. Gigi Osler told delegates that she felt fortunate being the eighth female president, the first female surgeon and the first female of colour to be president in the CMA’s 151-year history.

But the real strength and influence of the CMA comes from the members across the country, she said. Understanding local and regional perspectives is important and places the CMA in a better position to effect change, she said.

“As the national voice we want to understand the challenges you face.”

She said the CMA is working on MOUs with other provincial medical associations, and is looking forward to a deal with the SMA. The MOU would set out a process whereby the SMA and CMA would work toward the mutual success of both organizations. In her travels across Canada, she has heard the different challenges of each region, but this diversity of perspective has allowed her to view the medical profession with new eyes.

“At the CMA we want to use that perspective to make health care better. We want an ongoing conversation with you to make health and health care better,” Dr. Osler said.

She noted the understanding of physician health has evolved over time, with the focus shifting from helping individuals to changing workplace structures to be more supportive of physicians. The CMA has created a new department focusing on physician wellness and will collaborate with PTMAs and other groups to tackle issues around physician mental health, she said.

The CMA is also establishing a new task force on virtual care that will examine changes needed to deliver care virtually, including licensure to see what can be done to address recruitment issues in rural and remote communities. The task force is to report in 2020, Dr. Osler said, “bringing the health-care system into 20th century.”

Noting a federal election is looming for the fall, Dr. Osler said the CMA wants health care issues to be front and centre during the campaign.

“We look forward to mobilizing physicians to spread that message to all political parties.”

RA sessions

Dr. Scott McLeod, registrar for the Alberta College of Physicians and Surgeons, spoke on the top five characteristics of leadership he has learned in his career.

Dr. McLeod received his medical degree from the University of Saskatchewan in 1993, and his CCFP in 1995. He has a master’s in public health from the University of Texas and a master’s in public administration from the Royal Military College of Canada. He spent about 27 years with the Canadian Armed Forces, where he led health-care teams that executed strategic plans in a wide variety of health fields, including mental health, aerospace medicine, primary care, public health, and health research.

As director of medical health for the Canadian Armed Forces, Dr. McLeod developed the Surgeon General’s Mental Health Strategy. Through this work, he witnessed firsthand the importance of investing in support for mental health and the powerful returns of this investment.

His top five leadership points are:

Leaders need great teammates;

Leadership is fundamentally about improving the performance of the team you lead and the team you’re a part of;

Everyone on the team is essential to success;

Understand yourself, be yourself and always strive to improve yourself;

Leadership is not about the position you hold, but the trust you earn.

Dr. Bruce Cload, an emergency room physician at Royal University Hospital in Saskatoon, spoke on lessons he learned during the night of the Humboldt Broncos bus crash on April 6, 2018. Sixteen people affiliated with the Broncos died and 13 were injured, some seriously. The injured were stabilized at rural hospitals before being transported to RUH.

Dr. Cload has been part of the Saskatoon Health Region/Saskatchewan Health Authority since 2011 and has worked as a trauma team leader, intensivist, emergency physician as well as the operation lead and assistant chief of the emergency department. He is currently the operations executive, executive leadership council, department of emergency medicine, with the SHA and is also clinical assistant professor at the department of surgery, College of Medicine, U of S.

He said knowledge gained from prior events was applied in responding to the Broncos crash. These events included the La Loche school shootings on January 22, 2016, in which four people were killed and seven injured, and the crash of a West Wind flight near Fond du Lac on December 13, 2017. One person died and nine suffered serious injuries in that crash.

Dr. Cload said planning has to be in place ahead of time so emergency room workers know how to deal with an influx of patients. Also, information from the site has to be accurate. He noted that when news of the plane crash arrived at RUH, at first it was thought there were 30 people dead. That was changed to 20 people injured, then four injured. Five injured people actually arrived, one more than staff were prepared for.

The Broncos bus crash occurred at 4:56 p.m. The first patients arrived at Nipawin Hospital at 6:12 p.m. The first arrived at RUH at 9:50 p.m. and the last at about 3 a.m. Dr. Cload noted a decision had to be made whether to deploy all Saskatchewan Air Ambulance and STARS aircraft, as that would leave no air transport options for any other patient in Saskatchewan.

He said information from the scene was better than it had been for the plane crash, but was still not solid. Also, it was discovered that Alberta Air Ambulance, which deployed aircraft to help out, uses a different dispatch system, which had to be overcome. As for communication among hospital staff, email was the preferred medium.

“If you take one thing away from today, it is how are you going to communicate with your medical staff and all involved,” Dr. Cload told delegates.

He also said rather than an electronic system, a whiteboard was used to track patients – who they were and what they needed done. Three physicians expedited that process. Three other physicians were in charge of the ER, while six teams of physicians and health workers were each assigned a patient. The team followed their patient and did not worry about other patients. In essence decision-making was taken out of the hands of the trauma teams, Dr. Cload said.

In the aftermath, the flow of patients through the emergency department was difficult, he said. Equipment had been gathered from all over the hospital and was slowly returned to its proper place. Physicians working that night were given time off, meaning others were pulled in. Dr. Cload said there was no plan in place for dealing with the normal flow of the ER in the week that followed the bus crash.

Saturday sessions

On Saturday morning at the RA, two in-camera sessions were held to update delegates, one on the status of contract negotiations with the provincial government and the other on the progress of talks toward SHA Practitioner Staff Bylaws.

The next Representative Assembly will be November 1-2, 2019, at the Sheraton Cavalier in Saskatoon.